2016-2017 Special Student Declaration Form
Student Name: _____________________________ Student ID Number: __________________
Please check an answer: I will have a bachelor’s degree by July 1, 2016.  Yes  No
(If you answered YES, please complete question 1, 2, or 3. If you answered NO, please complete question 4 or 5.)
 1). I am enrolled in a teacher certification, recertification, or add-on certification program.*
 Please specify your teacher certification program and request a statement from the appropriate liaison
(back side of this form) verifying your program participation in a teacher certification program and
anticipated completion date. The statement should be sent to the Financial Aid Office by fax, email, or
regular mail.
UWSP Teacher Certification program: ____________________________________
I will finish my certification requirements in _____________________ of _________. (Month of Year)
 I have my ASHA Certificate of Clinical Competency (CCC) and am seeking WI DPI
certification.  Yes  No
Request the Chair of the School of Communicate Disorders to submit to the Financial Aid Office a
statement verifying your official enrollment in the program.
I plan to be eligible for the certification by _____________________ of _________. (Month of Year)
 I am seeking eligibility for graduate studies and future ASHA (CCC).  Yes  No
Request the Chair of the School of Communicate Disorders to submit to the Financial Aid Office a
statement verifying your official enrollment in the program.
I plan to be eligible for graduate studies by _____________________ of _________. (Month of Year)
 2). I am pursuing a second bachelor’s degree.*
Please specify your second degree major and request a statement from the appropriate liaison (back side
of this form) verifying your program participation in a second bachelor’s degree program and anticipated
completion date. The statement should be sent to the Financial Aid Office by fax, email, or regular mail.
First bachelor’s degree major is: ____________________________________
Second bachelor’s degree major is: ____________________________________
I will finish my second bachelor’s degree in _____________________ of _________. (Month of Year)
 3). I am a graduate student in the _____________________ department.
 4). I am enrolled in a degree-seeking program as an undergraduate student.
 5). I am enrolled as a special student and recognize that I do not qualify for financial aid.
I certify that the above information is true and correct to the best of my knowledge.
Student Signature: _______________________________ Date: ________________________
*Please note that students need to be enrolled at least half-time in order to be eligible for financial aid.
College and Department Contact Information
College of Professional Studies
Education, Teacher Certification & Second Degree
Associate Dean Kym Buchanan
College of Professional Studies (CPS) 472
715-346-2906 kbuchana@uwsp.edu
Communication Sciences and Disorders
Associate Dean Julia King
College of Professional Studies (CPS) 037
715-346-4657 julia.king@uwsp.edu
School of Business & Economics
Associate Dean Gary Mullins
College of Professional Studies (CPS) 424
715-346-3906 gary.mullins@uwsp.edu
College of Fine Arts & Communication
Interim Dean Rhonda Sprague
Noel Fine Arts Center (NFAC) 101
715-346-4920 rhonda.sprague@uwsp.edu
College of Letters & Science
Assistant Dean Dôna Warren
Collins Classroom Building (CCC) 130
715-346-4224 dona.warren@uwsp.edu
College of Natural Resources
Associate Dean Tim Ginnett
Trainer Natural Resources (TNR) 0342
715-346-4191 tginnett@uwsp.edu
School of Health Care Professions
Associate Dean Sue Raab
Science Building 127D
715-346-3766 sraab@uwsp.edu
Interior Architecture
Associate Dean Katja V. Marquart
College of Professional Studies (CPS) 330
715-346-4600 katja.marquart@uwsp.edu
Health Promotion & Human Development
Associate Dean Annie Wetter
College of Professional Studies (CPS) 101
715-346-2830 awetter@uwsp.edu
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